Florida Hospitals Find Collaboration on Quality Efforts Saves Lives

A collaborative effort by Florida hospitals led to significant improvements in patient outcomes according to five of the quality measures that affect hospital reimbursement. The Florida Hospital Association reported that participating hospitals reduced complications of surgery and infections of blood stream and urinary tract. Hospital readmissions within 15 days of discharge dropped by 15 percent in two years.

Readmissions

In 2008, Florida hospitals were the first in the nation to begin public reporting of readmissions. The same year, under via the Florida Collaborative on Readmissions,107 hospitals began to work with the state’s Agency for Health Care Administration, two information systems providers and a quality improvement expert to focus on reducing readmissions of five categories of patients, i.e., those admitted for heart failure, heart attack, pneumonia, hip replacement, or cardiac bypass surgery. Because of public reporting, the hospitals were able to track readmissions both at the initial hospital and at other hospitals. As a result, they recognized the need for greater communication between the hospitals, skilled nursing facilities and primary care providers.

Participating hospitals: (1) made sure that patients and their caregivers understood the post-discharge care plan and any medications at the time of discharge; (2) followed up with a phone call or personal visit; (3) improved the sharing of information among all providers as patients were transitioned from one setting to another; (4) discharged patients to the most appropriate settings; and (5) scheduled follow-up appointments with the patients’ physicians. The group consulted with the orthopedists’ association to develop a protocol for hip replacement patients. The Collaborative reported that 1,500 readmissions were prevented in two years, saving $25 million.

The Surgical Care Initiative

During a 15-month period, 67 hospitals focused on the prevention of post-surgical complications, emphasizing the outcomes for elderly patients and those who had undergone colorectal surgery. The group reported a 15.8 percent drop in surgical site infections and estimated that they had prevented 165 complications and prevented 89 deaths. The American College of Surgeons extended the two-year pilot for at least three more years, beginning in 2013.

Hospital-Acquired Infections

In 2009, 69 units in 35 hospitals began to focus on reducing central line-associated bloodstream infection (CLABSI), and 21 units in ten hospitals began a similar study of catheter-associated urinary tract infections (CAUTI). Another 16 neonatal intensive care units also participated in a perinatal quality effort with similar focus. The emphasis was on training staff in the science related to infection and creating an atmosphere in which all staff members felt free to speak up when they observed potential safety concerns. Over a two year period, CLABSIs were reduced by 41 percent, preventing 302 infections and saving 37 lives. Urinary tract infections dropped by 37 percent, compared to the reduction of 34 percent nationally. The collaboratives saved about $16 million.

Next Steps

The FHA reported that the next goal was to reduce harm to patients by 40 percent and hospital readmissions by 20 percent in three years. Within Florida, 74 hospitals continue to participate in the FHA’s hospital engagement network. Hospitals in 31 states may now participate in a broader project; they may choose to focus two or more areas out of ten, including adverse drug events, obstetrical adverse events, injuries from falls and immobility, and pressure ulcers in addition to the areas that were the focus of Florida’s efforts.